Analyse zeitveraenderlicher Kovariablen und rekurrenter Ereignisse am Beispiel einer Studie zur prophylaktischen Behandlung von Oesophagusvarizen

To assess the effect of prophylactic sclerotherapy on variceal hemorrhage and survival of patients with liver cirrhosis and esophageal varices, a randomized study had been carried out. We analysed the data from different points of view. The time-dependent Cox model and the linear counting process of Aalen are applied allowing for the time-dependent covariate ``variceal bleeding`` -- that switches up to three times -- in a multivariate analysis of the remaining life time. A model for the times to and between the recurrent events of bleeding including unobserved heterogeneity is estimated by a distribution-free and by a parametric method where the latter also admits time-dependent covariates such as repeated measurements of laboratory data. We find that high age, high Child-Pugh score and especially the first occurence of variceal bleeding have a statistically significant negative effect on survival whereas patients with fundic varices and/or alcoholic cirrhosis have a significant higher risk of bleeding. In both analyses, inclusion of time-dependent covariates does not change the estimation substantially. In particular, prophylactic sclerotherapy is not shown to reduce the risk of bleeding nor dying significantly

Podwyższony poziom greliny w stanie przedrzucawkowym: czy grelina jest przyjacielem czy wrogiem?

Objectives: To investigate maternal serum ghrelin levels in pregnancies complicated by preeclampsia and to explore the relationship between ghrelin level and disease severity. Materials and methods: This case-control study included 40 healthy pregnant women, 42 women with mild preeclampsia, and 40 women with severe preeclampsia. The groups were matched in terms of maternal and gestational age and body mass index. Serum ghrelin levels were measured via enzyme immunoassay. Results: Serum ghrelin levels were significantly higher in women with mild and severe preeclampsia than in healthy controls (p < 0.001). Although serum ghrelin levels were somewhat higher in the severe compared to the mild preeclampsia group, the difference was not statistically significant (p > 0.05). In the control group, no significant correlation was observed between ghrelin level and any other parameter, but in the preeclampsia group, serum ghrelin levels were negatively correlated with uterine artery Doppler index values and both systolic and diastolic blood pressure (all p-values < 0.05). Multivariate stepwise linear regression analysis revealed that systolic blood pressure (β = 0.493, p = 0.023) was independently associated with serum ghrelin level. Conclusion: Elevated blood ghrelin levels were correlated with disease severity in pregnancies complicated by preeclampsia.Cel pracy: Ocena poziomu greliny w surowicy kobiet w ciąży powikłanej stanem przedrzucawkowym i określenie związku między poziomem greliny a ciężkością choroby. Materiał i metoda: Do badania włączono 40 zdrowych kobiet w ciąży, 42 z łagodnym stanem przedrzucawkowym i 40 z ciężkim stanem przedrzucawkowym. Grupy były dobrane pod względem wieku ciążowego, wieku matek i wskaźnika masy ciała. Poziom greliny w surowicy był mierzony metodą immunoenzymatyczną. Wyniki: Poziom greliny w surowicy był istotnie wyższy u kobiet z łagodnym i ciężkim stanem przedrzucawkowym niż w grupie kontrolnej (p < 0,001). Chociaż poziom greliny w surowicy był wyższy w grupie z ciężkim stanem przedrzucawkowym niż w grupie z łagodnym stanem przedrzucawkowym, to ta różnica nie była istotna statystycznie (p > 0,05). W grupie kontrolnej nie obserwowano żadnych istotnych związków pomiędzy poziomem greliny a jakimkolwiek innym parametrem, ale w grupie ze stanem przedrzucawkowym poziom greliny w surowicy był ujemnie skorelowany z indeksami przepływów Dopplera w tętnicy macicznej oraz ciśnieniem krwi skurczowym i rozkurczowym (all p-values < 0,05). Wieloczynnikowa analiza regresji liniowej wykazała, że skurczowe ciśnienie krwi było niezależnym czynnikiem związanym z poziomem greliny w surowicy (β = 0,493, p = 0,023). Wnioski: Podwyższony poziom greliny we krwi był związany z ciężkością choroby w ciążach powikłanych stanem przedrzucawkowym

Soluble CD40 ligand and prolactin levels in migraine patients during interictal period

The relationship of migraine with cardiovascular diseases has been clarified by many studies, and currently, migraine is suggested to be a systematic vasculopathy. Inflammation, thrombosis and impaired vascular reactivity are the underlying pathophysiological mechanisms of the vasculopathy. In the present study, we aimed to investigate the relationship between prolactin levels and subclinical atherosclerosis risk factors such as soluble CD40 ligand (sCD40L) and high-sensitivity CRP (hsCRP) in migraine patients during interictal period. Fifty female migraine patients and age-matched 25 female control cases were enrolled in the study. Migraine diagnosis was settled according to the ICHD-II diagnostic criteria. A questionnaire was completed about the existence of vascular risk factors. Serum samples were used to measure sCD40L, hsCRP and prolactin levels. No difference was found between the prolactin levels of the migraine patients and the controls. The sCD40L levels were significantly higher in migraine patients (p < 0.001). High-sensitivity CRP levels showed no difference between the groups. There was no correlation between prolactin, sCD40L, and hs-CRP levels in migraine patients. We consider that the migraine patients are prone to subclinical atherosclerosis, but this tendency is independent of prolactin levels

Prevalence of sleep disorders in the Turkish adult population epidemiology of sleep study

Sleep disorders constitute an important public health problem. Prevalence of sleep disorders in Turkish adult population was investigated in a nationwide representative sample of 5021 Turkish adults (2598 women and 2423 men, response rate: 91%) by an interviewer‐administered questionnaire. Insomnia was defined by the DSM‐IV criteria, habitual snoring and risk for sleep‐related breathing disorders (SDB) by the Berlin questionnaire, excessive daytime sleepiness (EDS) by the Epworth sleepiness scale score, and restless legs syndrome (RLS) by the complaints according to the International Restless Legs Syndrome Study Group criteria. Mean age of the participants was 40.7 ± 15.1 (range 18 to 90) years. Prevalence rates (men/women) were insomnia 15.3% (10.5%/20.2%; P &lt; 0.001), high probability of SDB 13.7% (11.1%/20.2%; P &lt; 0.001), EDS 5.4% (5.0%/5.7%; P: 0.09), RLS 5.2% (3.0%/7.3%; P &lt; 0.001). Aging and female gender were associated with higher prevalence of sleep disorders except for habitual snoring. Prevalence rates of the sleep disorders among Turkish adults based on the widely used questionnaires were close to the lower end of the previous estimates reported from different parts of the world. These findings would help for the assessment of the health burden of sleep disorders and addressing the risk groups for planning and implementation of health care

Brain function assessment in different conscious states

Background: The study of brain functioning is a major challenge in neuroscience fields as human brain has a dynamic and ever changing information processing. Case is worsened with conditions where brain undergoes major changes in so-called different conscious states. Even though the exact definition of consciousness is a hard one, there are certain conditions where the descriptions have reached a consensus. The sleep and the anesthesia are different conditions which are separable from each other and also from wakefulness. The aim of our group has been to tackle the issue of brain functioning with setting up similar research conditions for these three conscious states.Methods: In order to achieve this goal we have designed an auditory stimulation battery with changing conditions to be recorded during a 40 channel EEG polygraph (Nuamps) session. The stimuli (modified mismatch, auditory evoked etc.) have been administered both in the operation room and the sleep lab via Embedded Interactive Stimulus Unit which was developed in our lab. The overall study has provided some results for three domains of consciousness. In order to be able to monitor the changes we have incorporated Bispectral Index Monitoring to both sleep and anesthesia conditions.Results: The first stage results have provided a basic understanding in these altered states such that auditory stimuli have been successfully processed in both light and deep sleep stages. The anesthesia provides a sudden change in brain responsiveness; therefore a dosage dependent anesthetic administration has proved to be useful. The auditory processing was exemplified targeting N1 wave, with a thorough analysis from spectrogram to sLORETA. The frequency components were observed to be shifting throughout the stages. The propofol administration and the deeper sleep stages both resulted in the decreasing of N1 component. The sLORETA revealed similar activity at BA7 in sleep (BIS 70) and target propofol concentration of 1.2 μg/mL.Conclusions: The current study utilized similar stimulation and recording system and incorporated BIS dependent values to validate a common approach to sleep and anesthesia. Accordingly the brain has a complex behavior pattern, dynamically changing its responsiveness in accordance with stimulations and states. © 2010 Ozgoren et al; licensee BioMed Central Ltd

Prevalence and risk factors of allergies in turkey (PARFAIT): Results of a multicentre cross-sectional study in adults

The Prevalence and Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate the prevalence of and risk factors for asthma and allergic diseases in Turkey. The present analysis used data from 25,843 parents of primary school children, obtained from a cross-sectional questionnaire-based study. A total of 25,843 questionnaires from 14 centres were evaluated. In rural areas, the prevalences asthma, wheezing, allergic rhinitis and eczema in males were: 8.5% (95% confidence interval (CI) 7.9-9.1%), 13.5% (95% CI 12.8-14.2%), 17.5% (95% CI 16.7-18.2%) and 10.8% (95% CI 10.211.4%), respectively; and in females were: 11.2% (95% CI 10.9-11.8%), 14.7% (95% CI 14.315.1%), 21.2% (95% CI 20.4-22.0%) and 13.1% (95% CI 2.4-13.8%), respectively. In urban areas, the corresponding prevalences in males were: 6.2% (95% CI 5.8-6.6%), 10.8% (95% CI 10.311.3%), 11.7% (95% CI 11.4-12.0%) and 6.6% (95% CI 6.2-7.0%), respectively; and in females were: 7.5 % (95% CI 7.9-7.1%), 12.0% (95% CI 11.7-12.3%), 17.0% (95% CI 16.4-17.6%) and 7.3% (95% CI 6.9-7.7%), respectively. Having an atopic first-degree relative or any other atopic diseases had significant effects on the prevalence of allergic diseases. Housing conditions, such as living in a shanty-type house, visible moulds at home and use of wood or biomass as heating or cooking material were associated with one or more allergic diseases. Although genetic susceptibility is strongly associated, country-and population-based environmental factors may contribute to increased prevalence rates of allergic diseases. Copyright © ERS Journals Ltd 2009

Postoperative pain intensity after using different instrumentation techniques: a randomized clinical study

Postoperative pain is a frequent complication associated with root canal treatment, especially during apical instrumentation of tooth with preexisting periradicular inflammation OBJECTIVES: The aim of this clinical study was to evaluate the influence of the instrumentation techniques on the incidence and intensity of postoperative pain in single-visit root canal treatment. MATERIAL AND METHODS: Ninety patients with single root/canal and non-vital pulps were included. The patients were assigned into 3 groups according to root canal instrumentation technique used; modified step-back, reciprocal, and rotational techniques. Root canal treatment was carried out in a single visit and the severity of postoperative pain was assessed via 4-point pain intensity scale. All the participants were called through the phone at 12, 24 and 48 h to obtain the pain scores. Data were analyzed through the Kruskal–Wallis test. RESULTS: There was significant difference between all groups (p<0.05). The modified step-back technique produced postoperative pain significantly lower than the rotational (p=0.018) and reciprocal (p=0.020) techniques. No difference was found between the reciprocal and rotational techniques (p=0.868). Postoperative pain in the first 12 h period (p=0.763) and in the 24 h period (p=0.147) was not significantly different between the groups. However, the difference in the 48 h period was statistically different between the groups (p=0.040). CONCLUSION: All instrumentation techniques caused postoperative pain. The modified step-back technique produced less pain compared to the rotational and reciprocal techniques